Dose-Dependent Enuresis in Methylphenidate Use.

OBJECTIVES: Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood. Although enuresis is a very common disorder in child diagnosed with ADHD, it may also develop because of methylphenidate. METHODS: Authors report here on a child case of ADHD that developed a probable enuresis related to methylphenidate. RESULTS AND CONCLUSIONS: Clinicians should be aware that methylphenidate used in ADHD causes dose-dependent enuresis.

Low-Dose Aripiprazole-Induced Nocturnal Enuresis in a 9-Year-Old Boy: A Case Report and the Possible Underlying Mechanism.

ABSTRACT: Aripiprazole is an atypical antipsychotic commonly used in the treatment of psychiatric disorders, such as schizophrenia, bipolar disorder, and irritability associated with autism spectrum disorder. Common adverse effects associated with aripiprazole usage in children and adolescents are nausea, vomiting, extrapyramidal adverse effects, akathisia, sedation, tremor, and increased appetite. Enuresis is one of the least expected adverse effects during aripiprazole use. The pathophysiology of aripiprazole-induced enuresis has not been fully clarified. To our knowledge, our report presents enuresis related to aripiprazole use at the lowest dose in the literature. In this report, we present the case of a 9-year-old boy who developed nocturnal enuresis after the beginning of low-dose aripiprazole treatment.

Methylphenidate-Induced Enuresis: 3 Case Reports.

ABSTRACT: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents. Methylphenidate (MPH) is one of the most widely used drugs in the treatment of ADHD. Enuresis can occur comorbidly with ADHD. However, enuresis is sometimes seen in patients with ADHD as an adverse effect of MPH treatment. In contrast, in some cases, MPH reportedly improves enuresis in patients with ADHD comorbid with enuresis. The literature is contradictory with regard to the relationship between MPH and enuresis. This report presents the cases of 3 children with ADHD who displayed enuresis during MPH treatment.

Sleep Architecture in Valproate-Induced Nocturnal Enuresis in Primary School and Preschool Children.

Nocturnal enuresis is one of the side effects of valproic acid treatment, and generally underdiagnosed by clinicians. Studies reported that a variable incidence of valproic acid-induced nocturnal enuresis is 2.2% to 24% with unclear explanations of the reasons behind valproic acid-induced nocturnal enuresis. A retrospective study was carried out on 260 children (aged 5-12 years) diagnosed with idiopathic epilepsy, treated with valproic acid to evaluate the nocturnal enuresis secondary to valproic acid, and to discuss the characteristics of their sleep architecture. Nocturnal enuresis was reported in 28 (10.7%) patients after a mean exposure time to valproate of 18.78±8.4 days. Nocturnal enuresis was significantly associated with younger age and serum level of valproate (P = .05). The polysomnographic study suggested that the underlying mechanism may be related to impaired sleep efficiency, frequent arousals, prolonged sleep latency, snoring, or increased sleep depth which may impair a child's ability to awaken to the sense of bladder fullness or contractions.Clinical trial registration: ClinicalTrials.gov identifiers: NCT04191863.

Low-dose Aripiprazole Induced Enuresis Continuum in a Child.

Aripiprazole is an atypical antipsychotic commonly used in the treatment of childhood disorders, such as bipolar disorder, psychosis, and irritability associated with autism spectrum disorder. Common side effects of its use include extrapyramidal side effects, somnolence, tremor, fatigue, nausea, and akathisia. Enuresis is an additional and rare side effect of aripiprazole use. There is limited data on the subject of enuresis induced as a result of treatment with aripiprazole. To our knowledge, there are no reports in the literature on aripiprazole-induced enuresis continuum in children. In this report, we present the case of a 9-year-old boy who developed enuresis continuum after the initiation of a low dose of aripiprazole and describe his rapid improvement when administration of the drug was ended.

Valproic acid-induced nocturnal enuresis in pediatric patients.

BACKGROUND: Valproic acid (VPA) is one of the commonly used antiepileptic drug. It has various side effects which may be fatal, such as fulminant hepatitis. Nocturnal enuresis (NE) has rarely been reported as side effect of VPA. The aim of this study is to evaluate the frequency of VPA-induced NE and discuss the possible reasons. MATERIALS AND METHODS: This retrospective cohort study was performed at the Department of Pediatric Neurology, Eskisehir Osmangazi University Hospital, in Eskisehir, Turkey, between April 2014 and April 2015. The patient population was generated from the epilepsy patients who were receiving VPA monotherapy. Control group population was generated from nonepileptic patients who visited our clinic for headache. Age range of the patients and the control group was determined to be 5-15 years. RESULTS: The patients group consisted of 189 (53.7%) boys and 163 (46.3%) girls and mean age of the patients was 9.1 ± 3.02 (5-15) years. The control group consisted of 92 (51.1%) girls and 88 (48.9%) boys and mean age of the patients was 8.75 ± 3.23 (5-15) years. We found the incidence of VPA-induced NE to be 5.7%. In the control group, incidence of NE was found to be 10.7%. CONCLUSION: This study is one of the largest series about VPA-induced NE. NE is a side effect of VPA that is generally overlooked by clinicians and slightly less well-known too. The literature on VPA-induced NE is very inadequate, and its etiology is not clear. In our study, we did not detect renal dysfunction in the patients with VPA-induced NE; therefore, we may speculate that the NE was caused by the increased sleep depth with VPA treatment. We believe that larger prospective studies including polysomnography may be helpful to shed light on the cause of VPA-induced NE.

Risperidone-Induced Nocturnal Enuresis Successfully Treated With Reboxetine.

There are few reports in the literature and scarce research on the topic and the treatment of antipsychotic medication-induced urinary incontinence or nocturnal enuresis (NE) despite the significant frequency of these adverse effects.Treatment for antipsychotic medication-induced urinary incontinence has been reported in relation to clozapine with response to numerous pharmacological strategies such as ephedrine, oxybutynin, intranasal desmopressin, trihexyphenidyl, and amitriptyline.We report a case of NE induced by risperidone which has been successfully treated with reboxetine.To the best of our knowledge, this article is the first report of an atypical antipsychotic medication-induced NE treated with reboxetine.Reboxetine may be an effective treatment for risperidone-induced NE. Further research is required to confirm our finding and apply this treatment for NE caused by other neuroleptics.

Iatrogenic nocturnal eneuresis ­ an overlooked side effect of anti histamines?

Nocturnal enuresis is a common disorder in childhood, but its pathophysiological mechanisms have not been fully elucidated. Iatrogenic nocturnal enuresis has been described following treatment with several psychotropic medications. Herein, we describe a 6-year-old child who experienced nocturnal enuresis during treatment with the antihistamine cetirizine. Drug rechallenge was positive. Several neurotransmitters are implicated in the pathogenesis of nocturnal enuresis, including noradrenaline, serotonin and dopamine. Antihistamine treatment may provoke functional imbalance of these pathways resulting in incontinence.

Pharmacological and behavioral management of some often-overlooked clozapine-induced side effects.

This article reviews four of the milder but still bothersome side effects of clozapine that are fairly frequent and may have a negative impact on patients' compliance with the treatment regime. We reviewed the available literature on the rate and management of four non-life-threatening side effects of clozapine, including hypersalivation, constipation, tachycardia, and nocturnal enuresis. We found a variety of pharmacological and behavioral strategies to manage these four side effects. There is, however, no consensus on a preferred strategy to control these distressing side effects and there are no guidelines. Psychiatrists should be aware of the relatively high rate of hypersalivation, constipation, tachycardia, and nocturnal enuresis in clozapine-treated patients, of the impact that these side effects may have on patients' quality of life, and should be able to suggest management strategies to the patients.

Nocturnal enuresis in patients taking clozapine, risperidone, olanzapine and quetiapine: comparative cohort study.

BACKGROUND: Nocturnal enuresis has been reported in patients taking clozapine, but the incidence has not been accurately established. The incidence of enuresis in patients taking risperidone, olanzapine or quetiapine is unknown. Aims To compare nocturnal enuresis in patients taking clozapine with that in patients taking risperidone, olanzapine or quetiapine. METHOD: Observational cohort study using prescription event monitoring methods. Patients prescribed atypical antipsychotic medicines were followed up by questionnaires that were sent to their medical practitioner. Practitioners were asked to directly ask their patients about bed-wetting. RESULTS: Nocturnal enuresis was reported by 17 of 82 (20.7%) patients taking clozapine, 11 of 115 (9.6%) taking olanzapine, 7 of 105 (6.7%) taking quetiapine and 12 of 195 (6.2%) taking risperidone. Compared with clozapine, the risk of nocturnal enuresis was significantly lower in patients taking olanzapine (odds ratio, OR = 0.43, 95% CI 0.19-0.96), quetiapine (OR = 0.33, 95% CI 0.13-0.59) or risperidone (OR = 0.27, 0.12-0.59), with odds ratios adjusted for age, gender and duration of treatment. CONCLUSIONS: Approximately one in five patients prescribed clozapine experienced bed-wetting. This was significantly higher than the rate of nocturnal enuresis in patients taking olanzapine, quetiapine or risperidone.

Methylphenidate-associated enuresis in attention deficit hyperactivity disorder.

This is a case report of possible association of methylphenidate and enuresis in an 11-year-old boy with attention deficit hyperactivity disorder.

Risperidone-induced enuresis in two children with autistic disorder.

INTRODUCTION: Risperidone appears to be effective in treating behavioral problems in children with autistic disorder. Although increased appetite, weight gain, and sedation are among the most common side effects, risperidone-induced enuresis is rarely reported. METHOD: We will present two cases with risperidone-induced enuresis, and discuss our findings in the context of current literature. RESULTS: Two children aged 11 and 10 years, diagnosed with autism and mental retardation, have developed new-onset diurnal and nocturnal enuresis respectively on their first and second weeks of risperidone monotherapy (1.5 and 1 mg/day). They did not experience sedation, and their medical history and workup were unremarkable. As enuresis did not resolve spontaneously, we decided to substitute risperidone with olanzapine. Enuresis ceased rapidly after discontinuation of risperidone with no emergence when patients were treated with olanzapine 5 mg/day for a period of 6 months and 1 year, respectively. DISCUSSION: Although the pathophysiology of antipsychotic-induced enuresis remains unclear, a number of mechanisms including alpha(1)-adrenergic blockade, dopamine blockade, and antimuscarinic effects has been proposed. Olanzapine has lower alpha(1)-adrenergic and dopaminergic blockade properties, thus changing risperidone to olanzapine may be an alternative modality in risperidone-induced enuresis when antipsychotic treatment is crucial. Clinicians should be more vigilant about screening for this side effect, especially in younger population with developmental disabilities.

Serotonin-selective reuptake inhibitor-induced enuresis in three pediatric cases.

Although there are reports on their use for the treatment of enuresis, we present three pediatric cases with serotonin-selective reuptake inhibitor (SSRI)-induced enuresis. Because SSRIs continue to be commonly prescribed in the pediatric population, the need to monitor for the possibility of enuresis precipitated by SSRIs is increasingly important.